ImportanceResearch on resilience after trauma has often focused on individual-level factors (eg, ability to cope with adversity) and overlooked influential neighborhood-level factors that may help mitigate the development of posttraumatic stress disorder (PTSD).ObjectiveTo investigate whether an interaction between residential greenspace and self-reported individual resources was associated with a resilient PTSD trajectory (ie, low/no symptoms) and to test if the association between greenspace and PTSD trajectory was mediated by neural reactivity to reward.Design, Setting, and ParticipantsAs part of a longitudinal cohort study, trauma survivors were recruited from emergency departments across the US. Two weeks after trauma, a subset of participants underwent functional magnetic resonance imaging during a monetary reward task. Study data were analyzed from January to November 2023.ExposuresResidential greenspace within a 100-m buffer of each participant’s home address was derived from satellite imagery and quantified using the Normalized Difference Vegetation Index and perceived individual resources measured by the Connor-Davidson Resilience Scale (CD-RISC).Main Outcome and MeasuresPTSD symptom severity measured at 2 weeks, 8 weeks, 3 months, and 6 months after trauma. Neural responses to monetary reward in reward-related regions (ie, amygdala, nucleus accumbens, orbitofrontal cortex) was a secondary outcome. Covariates included both geocoded (eg, area deprivation index) and self-reported characteristics (eg, childhood maltreatment, income).ResultsIn 2597 trauma survivors (mean [SD] age, 36.5 [13.4] years; 1637 female [63%]; 1304 non-Hispanic Black [50.2%], 289 Hispanic [11.1%], 901 non-Hispanic White [34.7%], 93 non-Hispanic other race [3.6%], and 10 missing/unreported [0.4%]), 6 PTSD trajectories (resilient, nonremitting high, nonremitting moderate, slow recovery, rapid recovery, delayed) were identified through latent-class mixed-effect modeling. Multinominal logistic regressions revealed that for individuals with higher CD-RISC scores, greenspace was associated with a greater likelihood of assignment in a resilient trajectory compared with nonremitting high (Wald z test = −3.92; P < .001), nonremitting moderate (Wald z test = −2.24; P = .03), or slow recovery (Wald z test = −2.27; P = .02) classes. Greenspace was also associated with greater neural reactivity to reward in the amygdala (n = 288; t277 = 2.83; adjusted P value = 0.02); however, reward reactivity did not differ by PTSD trajectory.Conclusions and RelevanceIn this cohort study, greenspace and self-reported individual resources were significantly associated with PTSD trajectories. These findings suggest that factors at multiple ecological levels may contribute to the likelihood of resiliency to PTSD after trauma.

中文翻译：

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与心理轨迹和创伤后奖励的神经反应相关的邻里资源


重要性关于创伤后复原力的研究通常集中在个体层面的因素（例如，应对逆境的能力），而忽视了可能有助于减轻创伤后应激障碍 （PTSD） 发展的有影响力的邻里层面因素。目的探讨住宅绿地与自我报告的个体资源之间的相互作用是否与弹性 PTSD 轨迹（即低/无症状）相关，并测试绿地与 PTSD 轨迹之间的关联是否由神经对奖励的反应性介导。设计、设置和参与者作为纵向队列研究的一部分，创伤幸存者是从美国各地的急诊科招募的。创伤后两周，一部分参与者在金钱奖励任务中接受了功能性磁共振成像。暴露每个参与者家庭住址 100 m 缓冲区内的住宅绿地来自卫星图像，并使用归一化差异植被指数和感知到的单个资源进行量化康纳-戴维森弹性量表 （CD-RISC）。主要结局和指标在创伤后 2 周、 8 周、3 个月和 6 个月测量 PTSD 症状的严重程度。奖励相关区域 （即杏仁核、伏隔核、眶额叶皮层） 对货币奖励的神经反应是次要结局。协变量包括地理编码 （例如，面积剥夺指数） 和自我报告的特征 （例如，儿童虐待、收入）。结果在 2597 名创伤幸存者（平均 [SD] 年龄，36.5 [13.4] 岁;1637 名女性 [63%];1304 名非西班牙裔黑人 [50.2%]，289 名西班牙裔 [11.1%]，901 名非西班牙裔白人 [34.7%]，93 名非西班牙裔其他种族 [3]。6%] 和 10 例缺失/未报告 [0.4%]），通过潜在类混合效应建模确定了 6 条 PTSD 轨迹 （弹性、非缓解性高、非缓解性中度、缓慢恢复、快速恢复、延迟）。多名词 logistic 回归分析显示，对于 CD-RISC 分数较高的个体，与非持续高分相比，绿地与弹性轨迹中分配的可能性更大相关（Wald z 检验 = -3.92;P < .001），非缓解性中度 （Wald z 检验 = −2.24;P = .03） 或恢复缓慢 （Wald z 检验 = -2.27;P = .02） 类。绿地还与杏仁核中对奖励的神经反应性较高有关 （n = 288;t277 = 2.83;调整后的 P 值 = 0.02）;然而，奖励反应性没有因 PTSD 轨迹而异。结论和相关性在这项队列研究中，绿地和自我报告的个人资源与 PTSD 轨迹显著相关。这些发现表明，多个生态水平的因素可能有助于创伤后对 PTSD 的恢复力的可能性。